Provider Demographics
NPI:1679710172
Name:SIOCO, REMEDIOS CAJUCOM (MD)
Entity Type:Individual
Prefix:MRS
First Name:REMEDIOS
Middle Name:CAJUCOM
Last Name:SIOCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33-49 UTOPIA PARKWAY, FLUSHING
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-359-2946
Mailing Address - Fax:718-359-2946
Practice Address - Street 1:33-49 UTOPIA PARKWAY, FLUSHING
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-359-2946
Practice Address - Fax:718-359-2946
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01712129Medicaid
NY01712129Medicaid